title: Signal detection theory approach to gastroesophageal reflux disease: a new method for symptom analysis of impedance-pH data.
abstract: An accurate reflux-symptom relationship analysis method is an unmet need in gastroesophageal reflux disease (GERD) diagnosis. The aim of this study was to adapt signal detection theory (SDT) approach to reflux-symptom relationship analysis to develop a new diagnosis method. Patients with predominant symptoms of heartburn and regurgitation were enrolled. Proton pump inhibitor (PPI)-responsive and PPI-unresponsive groups were created via interview and PPI trial. Patients then underwent stationary esophageal manometry and 24-hour multichannel intraluminal impedance-pH monitoring. SDT measurement parameters (discriminability: d' and criterion: c) were calculated using empirically selected time windows (0.5, 1, 2, 3, 4 and 5 minutes). The time window that provided the highest d' value was selected as the optimal time window. A cut-off d' value that optimally separates two groups was found using receiver operating characteristics analysis. Sixty-three patients completed the study (45 PPI responsive). Optimal time window and cut-off d' value were found as 1 and 0.767 minute, respectively. Symptom association probability (SAP) index values showed good correlation (rS = 0.7182, P < 0.0001) with d' values. SDT approach to reflux-symptom relationship analysis showed sensitivity (89% vs. 78%) and negative predictive values (75% vs. 60%) favorable over SAP index analysis. SDT approach using 1-minute time window and 0.767 cut-off d' value provides us a new and more accurate measure of reflux-symptom relationship than SAP index analysis.
authors.affiliation: Department of Gastroenterology, Medical Faculty of Marmara University, Istanbul, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Giral
authors.forename: R
authors.initials: R
authors.lastname: Kurt
authors.forename: E G
authors.initials: EG
authors.lastname: Yeğin
authors.forename: K
authors.initials: K
authors.lastname: Yeğin
mesh_terms: D000328:Adult; D017097:Electric Impedance; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D006356:Heartburn / Q000209:etiology; D006801:Humans; D064747:Lansoprazole / Q000627:therapeutic use; D057045:Laryngopharyngeal Reflux / Q000209:etiology; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012372:ROC Curve; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors; D064747:Lansoprazole
keywords: gastric regurgitation; gastroesophageal reflux disease diagnosis; heartburn; signal detection theory